EP4029497A1 - Neue verwendung von n, n-bis-2-mercaptoethyl-isophthalamid zur behandlung oder vorbeugung von paracetamol toxizität - Google Patents

Neue verwendung von n, n-bis-2-mercaptoethyl-isophthalamid zur behandlung oder vorbeugung von paracetamol toxizität Download PDF

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EP4029497A1
EP4029497A1 EP21211493.8A EP21211493A EP4029497A1 EP 4029497 A1 EP4029497 A1 EP 4029497A1 EP 21211493 A EP21211493 A EP 21211493A EP 4029497 A1 EP4029497 A1 EP 4029497A1
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Prior art keywords
paracetamol
formulation
toxicity
hours
administration
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EP21211493.8A
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English (en)
French (fr)
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Ragnar Axel Theodor KLINGBERG
Boyd Eugene HALEY
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Emeramed Ltd
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Emeramed Ltd
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
    • A61K31/166—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the carbon of a carboxamide group directly attached to the aromatic ring, e.g. procainamide, procarbazine, metoclopramide, labetalol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/16—Amides, e.g. hydroxamic acids
    • A61K31/165—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide
    • A61K31/167—Amides, e.g. hydroxamic acids having aromatic rings, e.g. colchicine, atenolol, progabide having the nitrogen of a carboxamide group directly attached to the aromatic ring, e.g. lidocaine, paracetamol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
    • A61K45/06—Mixtures of active ingredients without chemical characterisation, e.g. antiphlogistics and cardiaca
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P1/00—Drugs for disorders of the alimentary tract or the digestive system
    • A61P1/16—Drugs for disorders of the alimentary tract or the digestive system for liver or gallbladder disorders, e.g. hepatoprotective agents, cholagogues, litholytics
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K2300/00—Mixtures or combinations of active ingredients, wherein at least one active ingredient is fully defined in groups A61K31/00 - A61K41/00

Definitions

  • the present invention relates to new medical uses of the compound N,N-bis -2-mercaptoethyl isophthalamide (NBMI) and pharmaceutically acceptable salts and/or derivatives thereof.
  • NBMI N,N-bis -2-mercaptoethyl isophthalamide
  • the invention relates to the use of such compounds in treating or preventing the effects of paracetamol toxicity, which may occur due to the toxic effects of paracetamol overdose. More particularly, the invention may relate to the treatment or prevention of acute liver failure occurring as a result of paracetamol toxicity.
  • ALF Acute liver failure
  • paracetamol toxicity stands out as being particularly dangerous, not least due to its potential to cause rapid damage to liver tissue, often leading to irreparable damage to the liver and thus to irreversible liver failure.
  • Paracetamol also known as acetaminophen
  • acetaminophen is a widely used and effective pain killer for mild to moderate pain.
  • accidental paracetamol intoxication is a significant risk.
  • deliberate paracetamol intoxication through overdose has been used as a means for self-harm in those with suicidal tendencies.
  • paracetamol overdose is the most common form of intoxication from authorised medication, leading to over 100,000 emergency room visits per year in the US and the EU alone.
  • NAPQI N -acetyl- p -benzoquinone imine
  • NAC N -acetyl cysteine
  • NAC treatment rapidly diminishes if it is administered more than 8 hours after paracetamol ingestion, as the glutathione levels have then decreased too much (approximately below 70% of normal levels) and cannot bind to all of the NAPQI metabolite, which then causes damage to the liver. While NAC itself does bind to NAPQI in vitro, NAC is unable to halt an intoxication in vivo.
  • N , N - bis -2-mercaptoethyl isophthalamide was first disclosed in a patent application granted as US patent number US 6,586,600 B2 . Its use as a dietary supplement is disclosed in US patent application 2010/0227812 , and it is also known to be a chelator of heavy metals, such as mercury, cadmium and lead. Analogues of NBMI have been disclosed in, inter alia, granted US patent US 8,426,368 B2 , and international patent applications WO 2011/038385 and WO 2012/121798 .
  • NBMI NBMI
  • N,N-bis -2-mercaptoethyl isophthalamide (NBMI), or a pharmaceutically-acceptable salt and/or derivative thereof, for use in the treatment or prevention of paracetamol toxicity.
  • NBMI and pharmaceutically-acceptable salts and/or derivatives thereof may be referred to herein as "compounds of the invention”.
  • a method for the treatment or prevention of paracetamol toxicity comprises the administration of an effective amount of N , N - bis -2-mercaptoethyl isophthalamide, or a pharmaceutically-acceptable salt and/or derivative thereof, to a patient in need thereof (i.e. a patient of such treatment or prevention).
  • the compound NBMI as described herein may also be referred to by the trade name Irminix ® or by the international non-proprietary name (INN) Emeramide.
  • INN international non-proprietary name
  • the structure of the compound (in non-salt form) is represented below.
  • salts as referred to within the scope of the present invention include acid addition salts and base addition salts.
  • Such salts may be formed by conventional means; for example, by reaction of a free acid or a free base form of a compound of the invention with one or more equivalents of an appropriate acid or base, optionally in a solvent, or in a medium in which the salt is insoluble, followed by removal of said solvent, or said medium, using standard techniques (e.g. under reduced pressure, by freeze-drying or by filtration). Salts may also be prepared by exchanging a counter-ion of a compound of the invention in the form of a salt with another counter-ion, for example, using a suitable ion exchange resin.
  • carboxylate salts e.g. formate, acetate, trifluoroacetate, propionate, isobutyrate, heptanoate, decanoate, caprate, caprylate, stearate, acrylate, caproate, propiolate, ascorbate, citrate, glucuronate, glutamate, glycolate, ⁇ -hydroxybutyrate, lactate, tartrate, phenylacetate, mandelate, phenylpropionate, phenylbutyrate, benzoate, chlorobenzoate, methylbenzoate, hydroxybenzoate, methoxybenzoate, dinitrobenzoate, o-acetoxy-benzoate, salicylate, nicotinate, isonicotinate, cinnamate, oxalate, malonate, succinate, suberate, sebacate, fumarate, malate, maleate, hydroxymaleate, hippurate, phthalate or
  • carboxylate salts e.
  • sulphonate salts e.g. benzenesulphonate, methyl-, bromo- or chloro-benzenesulphonate, xylenesulphonate, methanesulphonate, ethanesulphonate, propanesulphonate, hydroxy-ethanesulphonate, 1- or 2- naphthalene-sulphonate or 1,5-naphthalenedisulphonate salts
  • Particular base addition salts that may be mentioned include salts formed with alkali metals (such as Na and K salts), alkaline earth metals (such as Mg and Ca salts), organic and inorganic bases (such as aluminium hydroxide). More particularly, base addition salts that may be mentioned include Mg, Ca and, most particularly, K and Na salts.
  • Particular pharmaceutically-acceptable salts that may be mentioned (in particular, when forming salts of NBMI) include base addition salts, such as those formed with alkali metals (e.g. salts formed with Na or K).
  • references to pharmaceutically-acceptable derivatives of NBMI will include compounds formed by derivatisation of NBMI following procedures known to those skilled in the art, such as through modification of one or more of the -NH- and/or -SH moieties therein.
  • references to such derivatives may include derivatisation of -NH- moieties through alkylation thereof (e.g. to form an -NR 1 -moiety, wherein R 1 represents C 1-3 alkyl optionally substituted with one or more fluoro group, such as wherein R 1 represents methyl) and/or derivatisation of -SH moieties through alkylation thereof (e.g.
  • R 2 represents C 1-3 alkyl optionally substituted with one or more fluoro group, such as wherein R 2 represents methyl) or esterification thereof (e.g. to form an -SC(O)R 3 moiety, wherein R 3 represents C 1-3 alkyl optionally substituted with one or more fluoro group, such as wherein R 3 represents methyl, or another moiety resulting from reaction of a pharmaceutically-acceptable compound capable of forming such thioesters, such as a pharmaceutically-acceptable carboxylic acid or ester).
  • NBMI neo-bis(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminoethyl-N-(2-aminoethyl)-2-aminol, 5-thioladenosine, L-homocysteine, co-enzyme A, 2-mercaptoethanol and dithiothreitol,.
  • Such derivatives may be prepared by analogy to the procedures described in, for example, US patent application 2011/0237776 , the contents of which are hereby incorporated by reference.
  • N N - bis -2-mercaptoethyl isophthalamide (NBMI), or a pharmaceutically-acceptable salt and/or derivative thereof
  • NBMI N - bis -2-mercaptoethyl isophthalamide
  • Particular compounds of the invention include NBMI and pharmaceutically-acceptable salts thereof.
  • More particular compounds of the invention that may be mentioned include NBMI.
  • compounds of the invention may exist as solids, and thus the scope of the invention includes all amorphous, crystalline and part crystalline forms thereof. Where compounds of the invention exist in crystalline and part crystalline forms, such forms may include solvates, which are included in the scope of the invention. Compounds of the invention may also exist in solution.
  • the present invention also embraces isotopically-labelled compounds of the invention, which are identical, but for the fact that one or more atoms are replaced by an atom having an atomic mass or mass number different from the atomic mass or mass number usually found in nature (or the most abundant one found in nature). All isotopes of any particular atom or element as specified herein are contemplated within the scope of the compounds of the invention.
  • references to the compounds of the invention also includes deuterated compounds, i.e. in which one or more hydrogen atoms are replaced by the hydrogen isotope deuterium.
  • references herein to the "treatment” of a particular condition take their normal meanings in the field of medicine.
  • the terms may refer to achieving a reduction in the severity of one or more clinical symptom associated with the condition.
  • references herein to "prevention” of a particular condition take their normal meanings in the art.
  • these terms may refer to achieving a reduction in the likelihood of developing the relevant condition or symptoms associated with the relevant condition (for example, a reduction of at least 10% when compared to the baseline level, such as a reduction of at least 20% or, more particularly, a reduction of at least 30%).
  • the term “preventing” may also be referred to as “prophylaxis" of the relevant condition, and vice versa.
  • references to "prevention” may refer to reducing the likelihood that the patient will experience the effects of paracetamol toxicity, such as liver damage (including ALF).
  • references to “treating” may refer to reducing the severity of the effects of paracetamol toxicity, such as liver damage (including ALF).
  • references to “patients” will refer to a living subject being treated, including mammalian (in particular, human) patients, and as such "patients” may also be referred to as “subjects”, and vice versa. References to “patients” (and therefore also to “subjects”) also should be considered to refer to individuals displaying no symptoms of the relevant condition, for whom compounds of the invention may be used as a preventative or prophylactic measure (as defined herein above).
  • references to patients may also include references to animals, such as non-mammalian animals (e.g. birds) and, particularly, mammalian animals (e.g. cats, dogs, rabbits, rodents, horses, sheep, pigs, goats, cows, primates, and the like).
  • non-mammalian animals e.g. birds
  • mammalian animals e.g. cats, dogs, rabbits, rodents, horses, sheep, pigs, goats, cows, primates, and the like.
  • the term "effective amount” will refer to an amount of a compound that confers the desired therapeutic effect on the treated subject (i.e. the desired treatment or prevention, as described herein).
  • the effect may be objective (i.e. measurable by some test or marker) or subjective (i.e. the subject gives an indication of and/or feels an effect).
  • paracetamol toxicity refers to a condition characterised by the clinical effects experienced following administration of a toxic dose (i.e. an overdose) of paracetamol.
  • a toxic dose i.e. an overdose
  • the treatment or prevention of paracetamol toxicity may also be referred to as the treatment of paracetamol overdose (which may be deliberate or accidental), paracetamol abuse (which may refer to deliberate paracetamol overdose), paracetamol poisoning (which may be deliberate or accidental) and the like.
  • paracetamol toxicity may be indicated by serum liver enzyme alanine transaminase (ALT) and/or aminotransferase (AST) levels above 1000 Unit/L. It may be characterised by hepatocellular necrosis (i.e. damage to the cells of the liver), which may in turn be characterised by impaired liver function and, in severe cases, acute liver failure (ALF). Such effects may initially (i.e. in the first 24 hours following paracetamol overdose) be characterised by symptoms such as nausea and vomiting, followed by the onset of right subcostal pain and tenderness, indicating the onset of liver damage.
  • ALT serum liver enzyme
  • AST aminotransferase
  • hepatocellular necrosis i.e. damage to the cells of the liver
  • ALF acute liver failure
  • Such effects may initially (i.e. in the first 24 hours following paracetamol overdose) be characterised by symptoms such as nausea and vomiting, followed by the onset of right subcostal pain and tenderness, indicating the onset
  • Toxic doses of paracetamol may occur through acute overdose (i.e. an overdose occurring as a resulting of a toxic amount being administered in any one dose) or chronic dose (i.e. an overdose occurring as a result of the cumulative effect of several doses).
  • acute overdose i.e. an overdose occurring as a resulting of a toxic amount being administered in any one dose
  • chronic dose i.e. an overdose occurring as a result of the cumulative effect of several doses.
  • cumulative daily doses above about 10 to 12 g (or about 150 mg/kg of body weight) and single doses about 4.5 to 6 g (or 75 mg/kg of body weight) are generally believed to be likely to induce toxicity.
  • paracetamol toxicity may occur at lower doses in patients with greater susceptibility to such toxicity, such as those experiencing impaired liver function (i.e. those experiencing impaired liver function independently of the immediate effects of paracetamol toxicity).
  • impaired liver function may be the result of malnutrition or fasting, a chronic condition (such as viral infection, e.g. hepatitis infection, or liver damage caused by chronic alcoholism) or an acute condition (such as impaired liver function caused by the effects of medication, i.e. medication other than paracetamol, or excessive alcohol consumption).
  • the treatment or prevention (e.g. the prevention) of paracetamol toxicity may be performed in patients known to have (or, in circumstances when a cautious approach is required, subjects thought to have) received (e.g. through ingestion) any greater than therapeutic dose of paracetamol, with reference to the standard therapeutic dose for any given patient as known to those skilled in the art (for example, a dose in adults of healthy weight of 1 g every 4 hours with a maximum of 4 g per 24 hour period).
  • paracetamol overdose may occur as a result of administration of paracetamol per se (e.g. in the form of paracetamol tablets, such as those typically formulated for oral administration, or via intravenous infusion) or in the form of a pharmaceutical formulation comprising paracetamol together with other active ingredients (such as formulations designed for the relief of the symptoms of common cold and influenza).
  • treatment or prevention of paracetamol toxicity as described herein should ideally be performed (i.e. should be commenced) as soon as possible after paracetamol overdose, such as within 72 hours (or, particularly, within 24 hours, such as within 12 hours or, more particularly, within 8 hours) of the overdose occurring.
  • treatment with compounds of the invention may also be effective in patients who have not been treated (for paracetamol overdose) within the initial period (e.g. the initial 24 hours or, more particularly, the initial 12 hours, such as with the initial 8 hours) following overdose, in which case the treatment may be performed in a period between 168 hours and 12 hours (e.g. between 72 hours and 12 hours, such as between 72 hours and 24 hours) after paracetamol overdose.
  • treatment with compounds of the invention may be performed in patients who have not been treated (for paracetamol overdose) within the initial 8 hours following overdose.
  • paracetamol toxicity may be characterised by acute liver failure.
  • the treatment or prevention of paracetamol toxicity as described herein may be performed in patients having or at risk of developing (e.g. patients at risk of developing) acute liver failure.
  • N N - bis -2-mercaptoethyl isophthalamide
  • NBMI N - bis -2-mercaptoethyl isophthalamide
  • a method for the treatment or prevention of acute liver failure associated with paracetamol toxicity comprises the administration of an effective amount of N , N - bis -2-mercaptoethyl isophthalamide, or a pharmaceutically-acceptable salt and/or derivative thereof, to a patient in need thereof (i.e. a patient of such treatment or prevention).
  • references to "acute liver failure associated with paracetamol toxicity" will be understood to refer to acute liver failure that is triggered by (or caused by) paracetamol toxicity, which may be referred to as acute liver failure resulting from paracetamol toxicity.
  • liver failure may be defined as the rapid development of hepatocellular dysfunction, characterised by the development of coagulopathy (typically with an international normalized ratio (INR) of greater than 1.5) and encephalopathy (typically characterised by mental status changes) in a patient without prior liver disease (e.g. without known prior liver disease). Further, it is generally understood that liver damage leading to acute liver failure may involve a loss of function in about 80% to about 90% of liver cells.
  • ILR international normalized ratio
  • impaired liver function refers to problematic sub-optimal liver function as determined by a clinician using techniques known to those skilled in the art.
  • liver function tests include those that measure the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma glutamyltransferase (GGT), bilirubin or albumin present in a patient's blood.
  • sub-optimal liver function may be identified through clotting studies (such as by assessing prothrombin time (PT) or international normalized ratio (INR)). The relevant results of these tests that are indicative of impaired or abnormal liver function are well known to the medical practitioner (or other persons skilled in the field).
  • treatment or prevention of paracetamol toxicity or acute liver failure associated with paracetamol toxicity may be combined with oral administration of activated charcoal or similar preparations.
  • treatment or prevention may be combined with administration (e.g. concomitant or sequential administration) of one or more other therapeutic agent useful in the treatment or prevention of paracetamol toxicity or acute liver failure associated with paracetamol toxicity as known to those skilled in the art, such as those described herein below.
  • references to “sequential administration” may refer to separate administration of the therapeutic agents as part of the same medical intervention (e.g. within four hours, such as within two hours or, particularly within one hour, of each other).
  • compounds of the invention may be particularly effective in preventing paracetamol toxicity or acute liver failure associated with paracetamol toxicity.
  • prevention of paracetamol toxicity or acute liver failure associated with paracetamol toxicity may be combined with treatment with paracetamol (e.g. the treatment of mild to moderate pain, fever or other similar conditions, such as through the administration of a therapeutically effective amount of paracetamol to a patient in need thereof, which treatment may be performed in a manner as known to those skilled in the art), or vice versa.
  • treatment with paracetamol e.g. the treatment of mild to moderate pain, fever or other similar conditions, such as through the administration of a therapeutically effective amount of paracetamol to a patient in need thereof, which treatment may be performed in a manner as known to those skilled in the art
  • Such combinations may be particularly useful when administered to patients with greater susceptibility to paracetamol toxicity, such as those described herein, and/or in patients receiving or requiring treatment with greater doses of paracetamol than those normally used (e.g. doses greater than 1 g every 4 hours with a maximum of 4 g per 24 hour period).
  • compositions and dosages are provided.
  • compounds of the invention may be administered in a manner allowing for systemic absorption, which absorption may occur via a number of possible routes; for example, compounds of the invention may be administered orally, intravenously or intraarterially, intramuscularly, cutaneously, subcutaneously, transmucosally (e.g. sublingually or buccally), rectally, transdermally, nasally, pulmonarily (e.g. by inhalation, tracheally or bronchially), or by any other parenteral route, in the form of a pharmaceutical preparation comprising the compound in a pharmaceutically acceptable dosage form.
  • compounds of the invention may be administered orally, rectally or intravenously (e.g. by intravenous infusion).
  • the compounds of the invention will generally be administered in the form of one or more pharmaceutical formulations in admixture with a pharmaceutically acceptable excipient, which may be selected with due regard to the intended route of administration and standard pharmaceutical practice.
  • a pharmaceutically acceptable excipient may be chemically inert to the active compounds and may have no detrimental side effects or toxicity under the conditions of use.
  • Such pharmaceutically acceptable excipients may also impart an immediate (e.g. rapid), or a modified (e.g. delayed), release of the compounds of the invention.
  • Suitable pharmaceutical formulations may be commercially available or otherwise are described in the literature (see, for example, Remington The Science and Practice of Pharmacy, 19th ed., Mack Printing Company, Easton, Pennsylvania (1995 ) and Martindale - The Complete Drug Reference (35th Editi on), and the documents referred to therein), the relevant disclosures in all of which documents are hereby incorporated by reference. Otherwise, the preparation of suitable formulations may be achieved non-inventively by the skilled person using routine techniques. Suitable pharmaceutical formulations for use with the compounds of the invention are also described in US patent application 2010/0227812 .
  • a pharmaceutical composition comprising N , N - bis -2-mercaptoethyl isophthalamide, or a pharmaceutically-acceptable salt and/or derivative thereof, and optionally one or more pharmaceutically-acceptable excipient, for use in:
  • references herein to pharmaceutically acceptable excipients include references to a pharmaceutically acceptable adjuvant, diluent and/or carrier, which adjuvants, diluents and carriers will be known to those skilled in the art (as described herein).
  • pharmaceutical formulations may be prepared in a manner suitable for the desire route of administration, using techniques and materials known to those skilled in the art.
  • pharmaceutical formulations may take the form of oral formulations or intravenous formulations (or formulations, e.g. concentrated formulations, suitable for use in the preparation of intravenous formulations).
  • pharmaceutical formulations comprising compounds of the invention when intended for oral administration, pharmaceutical formulations comprising compounds of the invention may be provided in the form of a tablet, or an oral powder or solution, each optionally comprising suitable excipients, which may be prepared using techniques known to those skilled in the art.
  • pharmaceutical formulations comprising compounds of the invention when intended for intravenous (I.V.) administration, pharmaceutical formulations comprising compounds of the invention may be provided in the form of solutions suitable for I.V. administration, or as solutions suitable for the preparation of solutions suitable for I.V. administration, which may be prepared using techniques known to those skilled in the art.
  • pharmaceutical formulations comprising compounds of the invention when intended for rectal administration, pharmaceutical formulations comprising compounds of the invention may be provided in the form of a tablet (e.g. a suppository), or a powder or solution, each optionally comprising suitable excipients, which may be prepared using techniques known to those skilled in the art.
  • compounds of the invention may be administered at varying therapeutically effective doses (to the relevant patient in need thereof). Suitable doses may be determined by the skilled person using routine techniques, such as by routine dose titration studies and the like.
  • the amount of the compounds of the invention included in the relevant pharmaceutical formulations may be determined based on the desired dosage of the compound of the invention, the ease of formulation and the route of administration (which may in turn determine the availability of the compound of the invention for systemic absorption).
  • Suitable doses of the compounds of the invention may include dosages (e.g. for I.V. administration) in the range of from about 0.05 to 300 mg/kg, such as from about 0.5 to about 200 mg/kg (e.g. about 1 to about 100 mg/kg, such as about 5 mg/kg or about 50 mg/kg).
  • such doses may be administered by I.V. administration, orally or rectally (e.g. by I.V administration), over a period of time, such as about 15 minutes, one hour or several hours (e.g. one hour).
  • I.V administration orally or rectally
  • a period of time such as about 15 minutes, one hour or several hours (e.g. one hour).
  • doses may be repeated as necessary, such as in the form of periodic, sequential infusions, which infusions may be of decreasing dose.
  • compounds of the invention administered (e.g. to a human) should be sufficient to effect the desired therapeutic response or preventative effect within (and over) a reasonable timeframe.
  • compounds of the invention may be provided in a form suitable for rapid (i.e. quick or immediate) release of the active ingredient(s), such as in the form of a rapidly disintegrating tablet, which tablets may be formulated using techniques and materials known to those skilled in the art.
  • Administration of the compounds of the invention may be continuous (e.g. by continuous I.V. infusion) or intermittent (e.g. by bolus injection or through periodic administration of a tablet or solution, orally or rectally, such as by bolus injection or through periodic administration of a tablet or solution), or may be provided in the form of a single dose (e.g. by injection or through administration of a tablet or solution).
  • the dosage form may also be determined by the timing and frequency of administration, and vice versa.
  • the compounds of the invention may also be combined with one or more active ingredients that are potentially useful, or have been indicated for use, in the treatment of liver disorders.
  • a pharmaceutical formulation comprising:
  • kit-of-parts comprising components:
  • kits-of-parts described herein may comprise more than one formulation including an appropriate quantity/dose of the compounds of the invention, and/or more than one formulation including an appropriate quantity/dose of one or more other therapeutic agent capable of treating or preventing paracetamol toxicity, in order to provide for repeat dosing. If more than one formulation (comprising either active compound) is present, such formulations may be the same, or may be different in terms of the dose of either compound, chemical composition(s) and/or physical form(s).
  • kits-of-parts as described herein, by “administration in conjunction with” (and similarly “administered in conjunction with”) we include that respective formulations comprising the compounds of the invention, and one or more other therapeutic agent capable of treating or preventing paracetamol toxicity, are administered, sequentially, separately or simultaneously, as part of the same medical intervention.
  • the term "administration in conjunction with” includes that the two active ingredients (i.e. a compound of the invention, and one or more other therapeutic agent capable of treating or preventing paracetamol toxicity) are administered (optionally repeatedly) either together, or sufficiently closely in time, to enable a beneficial effect for the patient, that is greater, over the course of the treatment of the relevant condition, than if either a formulation comprising a compound of the invention, or a formulation comprising one or more other therapeutic agent capable of treating or preventing paracetamol toxicity, or pharmaceutically acceptable salt thereof, are administered (optionally repeatedly) alone, in the absence of the other component, over the same course of treatment. Determination of whether a combination provides a greater beneficial effect in respect of, and over the course of, treatment or prevention the relevant condition may be achieved routinely by the skilled person.
  • the term "in conjunction with” includes that one or other of the two formulations may be administered (optionally repeatedly) prior to, after, and/or at the same time as, administration of the other component.
  • the terms “administered simultaneously” and “administered at the same time as” include that individual doses of a compound of the invention and one or more other therapeutic agent capable of treating or preventing paracetamol toxicity are administered within 24 hours (e.g. within 12 hours, 6 hours, 3 hours, 2 hours, 1 hour, 45 minutes, 30 minutes, 20 minutes or 10 minutes) of each other.
  • kit-of-parts comprising:
  • Suitable therapeutic agents useful in the treatment or prevention of paracetamol toxicity include anti-oxidants and chelators, such as vitamin-E, vitamin-D, cysteine, cystine, glutathione, lipoic acid glutathione (GSH), dihydrolipoic acid (DLPA), lipoic acid (LPA), N-acetylcysteine (NAC), dimercaptopropane sulfonate (DMPS), dimercaptosuccinic acid (DMSA), ethylenediaminetetraacetic acid (EDTA), Deferoxamine (DFO), Deferasirox, Deferiprone, Trientine, D-penicillamine, ammonium tetrathiomolybdate, choline tetrathiomolybdate, and combinations thereof.
  • anti-oxidants and chelators such as vitamin-E, vitamin-D, cysteine, cystine, glutathione, lipoic acid glutathione (GSH), dihydrolipoic acid (
  • N-acetylcysteine N-acetylcysteine
  • the pharmaceutical formulation or kit-of parts may be for use in:
  • the pharmaceutical formulation or kit-of parts may be used in a method for:
  • compounds of the invention may be particularly effective in preventing paracetamol toxicity or acute liver failure associated with paracetamol toxicity, and may therefore be useful in administration in combination with paracetamol (e.g. where such paracetamol is used in the treatment of mild to moderate pain or fever, as known to those skilled in the art), particularly in patients with greater susceptibility to paracetamol toxicity (as described herein) and/or those receiving or requiring treatment with greater doses of paracetamol than those normally used (e.g. doses of 1 g every 4 hours with a maximum of 4 g per 24 hour period).
  • a pharmaceutical formulation comprising:
  • kit-of-parts comprising components:
  • kit-of-parts comprising:
  • the pharmaceutical formulation as described in the sixth aspect of the invention and the kit-of-parts as described in the seventh aspect of the invention may be for use in (or may be used in a method for) the treatment of:
  • Suitable doses of other therapeutic agents referred to herein will be known to those skilled in the art and include those listed for the drugs in question in the relevant medical literature, such as in Martindale - The Complete Drug Reference (35th Editi on) and the documents referred to therein, the relevant disclosures in all of which documents are hereby incorporated by reference.
  • NBMI may be prepared in accordance with the procedure described in US patent number US 6,586,600 B2 , the contents of which (in particular, the procedures as described in the examples provided therein) are hereby incorported by reference.
  • pharmacetical formulations including those containing more than one active ingredient as described in the fourth aspect of the invention
  • a kit-of-parts may be prepared using techniques known to those skilled in the art.
  • components (A) and (B) of the kit-of-parts as described in the fifth and seventh aspects of the invention may be:
  • compounds of the invention may have the advantage that, in the treatment or prevention of paracetamol toxicity or acute liver failure associated with paracetamol toxicity, may be more convenient for the physician and/or patient than, be more efficacious than, be less toxic than, have a broader range of activity than, be more potent than, produce fewer side effects than, or that it may have other useful pharmacological properties over, similar treatments or preventative measures known in the prior art.
  • NBMI has the ability to effectively bind NAPQI in vivo, thus providing an effective means for directly blocking the in vivo effects of paracetamol toxicity (rather than acting as a precursor to glutathione, as is the case with agents such as NAC).
  • the calcium ion channel TRPA 1 is activated by NAPQI. This activation may be determined by ratiometric calcium imaging.
  • HEK 293 cells expressing human TRPA1 were pre-incubated with 7 ⁇ M NAPQI and the calcium fluorophore FURA II.
  • One experiment was run in the presence of 4 ⁇ M NBMI and the another was run in the presence of 4 ⁇ M NAC.
  • NAPQI caused about 55% receptor activation.
  • Figure 1 the presence of 4 ⁇ M NBMI almost completely inhibited the activation of the receptor, whereas the presence of 4 ⁇ M NAC gave only partial inhibition.
  • the two lines marked with NBMI concentrations in Figure 2b show that the concentration of cys-paracetamol is lower when NBMI has been taken prior to paracetamol administration, showing that 600 mg NBMI taken one hour prior to paracetamol administration decreased the area under the curve (AUC) by 23%, and that 1,200 mg NBMI taken two hours before paracetamol administration decreased it by 73%.
  • liver enzyme alanine transaminase (ALT) level is about 36-40 unit/L and the liver enzyme aspartate transaminase (AST) level is about 90 unit/L.
  • ALT alanine transaminase
  • AST aspartate transaminase
  • the ratio of AST:ALT can also be relevant in humans; a value at or below 1 is considered to indicate toxicity.
  • mice fasted overnight, each received a toxic dose 700 mg/kg paracetamol (acetaminophen) per os. 20 minutes later, half of the mice (3) were administered vehicle (0.5 % (w/v) carboxymethylcellulose 300-600 centipoises in water) only, half of the mice (3) received NBMI 100 mg/kg per os (NBMI dissolved in CMC as described below). All mice are sacrificed using anesthesia after 48 hours or earlier if required.
  • vehicle 0.5 % (w/v) carboxymethylcellulose 300-600 centipoises in water
  • the median ALT level in control mice is 13,680 Unit/L, approximately 380 times higher than normal levels (36 unit/L), and 13 times the toxic level in humans (1,000 unit/L).
  • the median ALT level in the NBMI treated group is 624 unit/L, thus about 95% lower than the median of the intoxicated animals, and under the toxic level for humans.
  • APAP acetaminophen
  • the results of the AST assay are shown in Figure 5 .
  • the intoxicated mice had AST levels of approximately 6,000 unit/L.
  • Administration of NAC kept AST at 180.
  • Administration of NBMI at 200 mg/kg kept the ALT level at 600.
  • mice that had fasted were injected i.p. with an 200mg/kg paracetamol, and synchroneously with either an oral dose of either (i) 680 mg/kg NBMI in CMC vehicle (carboxymethylcellulose sodium salt of medium viscosity), or (ii) CMC vehicle alone; dosing volume 5 ⁇ L/gram body weight.
  • the NBMI dose was chosen as it has in 28-day-toxicity studies shown to provide a similar exposure as a 4.5-9 mg/kg dose in humans, a dose showing no drug related adverse events in clinical trials. Mice were sacrificed at 24 hours after adminstration, following which levels of liver enzymes AST and ALT were measured.
  • mice were treated. One result was discounted as an outlier (based on Grubbs' test for outliers, and due to hemolysis having been observed). An average of the results obtained from the remaining mice showed:
  • N N - bis -2-mercaptoethyl isophthalamide (NBMI), or a pharmaceutically-acceptable salt and/or derivative thereof, for use in the treatment or prevention of paracetamol toxicity.
  • NBMI N - bis -2-mercaptoethyl isophthalamide
  • a method for the treatment or prevention of paracetamol toxicity comprises the administration of an effective amount of N , N - bis -2-mercaptoethyl isophthalamide, or a pharmaceutically-acceptable salt and/or derivative thereof, to a patient in need thereof.
  • a method for the treatment or prevention of acute liver failure associated with paracetamol toxicity comprises the administration of an effective amount of N,N-bis -2-mercaptoethyl isophthalamide, or a pharmaceutically-acceptable salt and/or derivative thereof, to a patient in need thereof.
  • a pharmaceutical formulation comprising:
  • kit-of-parts comprising components:
  • a pharmaceutical formulation comprising:
  • kit-of-parts comprising components:

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US8426368B2 (en) 2010-03-25 2013-04-23 The University Of Kentucky Research Foundation Method of ameliorating oxidative stress and supplementing the diet
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